Transforming the delivery of NCD and mental health services

Transforming the delivery of NCD and mental health services in primary health care: Launch of the fourth cycle of the NCD Lab

Grassroots innovation interview series

The NCD Lab on Women and Girls, which The George Institute for Global Health co-chairs with the World Health Organization (WHO), is a virtual platform that aims to accelerate progress towards achieving the non-communicable-disease (NCD) and NCD-related SDGs. We and our expert Steering Group are looking for innovative submissions that promote gender equity and recognise and address the role of gender in the determinants and impacts of NCDs, as well as the links between NCDs and gender inequalities and how these reinforce each other. For its fourth cycle, the NCD Lab is inviting submissions of innovative and impactful solutions that transform how NCD and mental health services are delivered in primary care. This article is part of an interview series featuring NCD Lab innovators, partners, and stakeholders. Claudia Selin Batz, Policy and Advocacy Advisor at The George Institute shares how grassroots innovations can drive equitable and sustainable solutions to addressing NCDs and how these innovations can be sustainably scaled for impact.

Why are innovative grassroots solutions needed to address NCDs among women and girls?

Local solutions developed by women and girls are uniquely positioned to navigate cultural norms and traditions, ensuring that interventions to address NCDs are not only addressing the needs, but are also accepted within the community. This cultural sensitivity is essential for overcoming barriers to healthcare-seeking behaviours. Collaboration with local communities builds trust, understanding, and support for the solutions being developed. For example, creating health education programs that raise awareness about NCD risk factors (such as unhealthy diets, air pollution, tobacco, and alcohol use) and focus on prevention and management, using traditional storytelling and local languages, can effectively engage and empower people to take charge of their health.

Culturally sensitive approaches seek innovative solutions within cultures and works with them. This may involve incorporating indigenous knowledge into healthcare services for NCD management by partnering with traditional healers and practitioners. Communities can evaluate their cultural values and practices to discern whether they hinder or promote human rights achievements. They can capitalise on positive aspects and address negative ones to develop culturally appropriate, human rights-based, and gender-equitable solutions. Additionally, the resulting innovations themselves can deepen understanding of cultural traditions. This could be facilitated through peer support groups and networks for individuals living with NCDs to exchange experiences and insights.

What are some promising examples of grassroots innovations that address NCDs among women and girls (from NCD Lab or otherwise)? What has been promising, interesting, or striking about it/them?

One noteworthy innovation is the SMARThealth Pregnancy programme developed by The George Institute in collaboration with Oxford University. This low-cost, smartphone-based system is used by female community health workers to identify pregnant and postpartum women at considerable risk for NCDs such as heart disease, stroke, and diabetes. The mobile application facilitates referrals to primary health care facilities and establishes two-way communication between health workers and primary care providers, ensuring timely follow-up and adherence to medications and lifestyle advice.

The feedback from the community has been promising, particularly considering the limited knowledge globally about supporting integrated NCD services in practice. The project highlights the value of co-creating programs with local communities and involving them as implementers, which contributes to significant advances in building trust in seeking support and healthcare. It has also demonstrated improvements in delivery efficiency and the strengthening of the capacity of community health workers, who are often perceived as low-skilled. In Malang, Indonesia, the SMARThealth app has been instrumental in detecting and preventing cardiovascular disease, the leading cause of death among women.

Research findings from the project revealed compelling outcomes. After being identified as considerable risk by SMARThealth, 57% of individuals were using blood pressure medication, compared to only 16% in villages without the intervention. Additionally, the innovation enhanced the role of community health workers by connecting them with doctors through the app, boosting their status within the community.

Recognizing the success of grassroots innovations, the Indonesian government awarded the program the innovation award in 2019, leading to its scaling up to reach more residents in the region. The commitment of the government to fund this expansion from local funds underscores the promising sustainability of the initiative.

What would be your advice to teams wishing to submit their project to the NCD Lab’s thematic area on “Women and Girls”?

To try and identify and address barriers to access and risks specific to women and girls in their context. The NCD Lab is interested in evidence-informed submissions that support communities in great need and articulate clear and feasible milestones in the project plan. Submissions can encompass new ideas or innovations that have been previously piloted, but it will be important to highlight potential for scalability. Developing a robust monitoring and evaluation framework is also desirable and will allow for the assessment of both project success and the quality of implementation.

The NCD Lab has received highly innovative proposals, such as the Healthy Woman project in Kenya, which was recognised as gender transformative because it addresses unequal gender roles through health education and hands-on training in agri-nutrition. It empowers women to reclaim decision-making in the traditionally male-dominated realm of land management, enabling them to make healthy choices regarding food and nutrition for themselves, their families, and their households.

When preparing your submission, I would advise teams to consider similar transformative approaches that can address several NCD risk factors and developed a comprehensive monitoring and evaluation framework.

Since its launch in 2021, the NCD Lab has identified multiple promising grassroots innovations on NCDs and supported them to achieve greater scale and impact. Through its annual calls for submissions, the NCD Lab welcomes innovative projects that respond to pressing health issues, country needs, and implementation opportunities. The call for submissions for the fourth cycle will remain open until June 30, 2024.

This article was originally published on the World Health Organization (WHO) Knowledge Action Portal on NCDs (KAP), a knowledge sharing, and community platform dedicated to enhancing NCD prevention and control through multisectoral and multistakeholder collaboration. The KAP is hosted by the World Health Organization’s Global Coordination Mechanism on the Prevention and Control of Non-communicable diseases.